“Don’t be so bloody academic about it”: university approaches to mental health
Support, adaptation and security when studying for people experiencing mental health difficulties shouldn’t be a gift. They should be a right.
The following is a speech given by Mark Brown at Universities UK ‘Mental health: A whole university approach’ at Woburn House, London on 11th July 2019.
On June 13th, BBC news reported the results of the Higher Education Policy Institute (Hepi) and Advance HE Student Academic Experience Survey, noting Only 14% of students reported “life satisfaction”, with “just 18% saying they were happy, 17% saying their life was “worthwhile” and only 16% having low levels of anxiety.”
The headline grabber was the finding that of the 14,000 students surveyed “66% supported universities being able to share concerns with parents or a trusted adult if there were “extreme” problems — and a further 15% thought universities should be able to contact parents in “any circumstances” where there were mental health worries.”
I tweeted at the time: “A University response which is ‘come get your daughter or son they’ve gone mental’ still situates the failing in the individual. Who is to say ‘going home to your parents’ is best response to mental ill-health? It’s certainly a neat way of shuffling you out of the student body
“I think, for me, question is: what obligation do universities have to make it possible for undergraduates to continue their studies if they experience #mentalheath difficulties and what moral obligation do they have to prevent or mitigate those difficulties in the first place?
“I think it’s telling that young people at university can’t imagine the institution being different and that they can only imagine an intercession from outside the institution (‘parents should be told’) to save those experiencing #mentalhealth difficulty while studying.”
Why is it so hard for students to imagine the institution of university working differently to the way it does? It’s because it feels like the British Motorway system: beautiful and strange, been around forever, never going to change.
It’s not me it’s you. Talk to people that university isn’t working for
We still tend to individualise ‘failure’ at university. For institutions that collect together the greatest minds of their generation; there seems to be a surprising lack of examining how university as an institution is institutionally and structurally prejudiced against students who have mental health difficulties or who develop them while studying. I want to ask ‘what happens when we say, it’s not me, the student, it’s you?’ What might we do if we didn’t treated mental health difficulty at university as a chance happening and instead planned for it?
Back in 2017 I wrote a piece for Prospect about the IPPR report “Not by Degrees: Improving Student Mental Health in the UK’s Universities’:
“According to the IPPR in 2015/16, 15,395 first year students (2 per cent) disclosed to their university that they experienced a mental health difficulty — almost five times the number in 2006/07. In 2014/15, 1180 students who experienced mental health difficulty dropped-out of university, an increase of 210 per cent compared to 2009/10. Just under half of students who report experiencing a mental health condition choose not to disclose it to their university, so the number of students potentially struggling is far higher.”
Musing on some of the challenges of thinking about the institution of university and the mental health of those within it I wrote: “In many ways, the cultural and political discourse of our country is defined by those who were successful at university. In the past, a “what doesn’t kill you makes you stronger” rhetoric has clouded discussion about student mental health, reminiscent of misty-eyed men in gentlemen’s clubs lamenting the passing of the cane in schools. Today, right wingers label universities as liberal breeding grounds for “special snowflakes” demanding equally special treatment.
“That universities are institutions with common values supported by public funds should make it easier for us to create support and protection for the mental health of those attending them that is practical, not rhetorical. The issue is not accepting those with mental health difficulties via a welcoming mission statement but taking action, and providing resources to support them to thrive.”
Recently, I heard someone say that the way to improve something is to look at the people that it doesn’t work for, to see how they differ from the people for whom it does work and how they differ from each other.
There is a massive survivorship bias in discussions about what universities might do better. The people who do the talking in spaces that are listened to are generally the ones who somehow, against the odds, managed to make things work.
In common language we still use phrases like ‘dropping out’ where we would never think of using it when talking about people who found themselves too unwell or distress to work.
Shame is real and toxic
Experiencing mental health difficulty can be terrifying, especially if it is a new experience. We know that undergraduates going to university straight from school do so during the period of life where it is common for people to experience their first protracted experiences of mental health difficulty. Imagine knowing something was up and then trying to answer the question ‘what do I do now I know I’m not keeping it together?’
I wrote a piece last year speaking to people who had been hiding their mental ill health from their employers. One person told me that one of the things that kept her from revealing how much she was struggling was the worry of having her own worst fears about herself confirmed.
She told me: “There was a sense of shame and feeling there was something wrong with me. Admitting that there was a problem felt like admitting that I wasn’t up to the task of being a human.Shame is just the most toxic thing. If you say ‘I’m struggling’ they might say ‘well, yeah we think you’re crap’.”
One of the reasons people don’t access help is often that it is unclear what will happen as result of accessing that help. The idea of approaching your course tutor is assumed to be easy, or trying to seek out counselling or mental health support. But it isn’t if you fear being thrown off your course or something worse. Lack of clear guidance, lack of clear offers of support and lack of structure in support makes mental health at university far more difficult than it needs to be.
Yes, studying should be rigorous and tough. But it should also be adaptable and able to accommodate students who are experiencing hardship and disadvantage because of the challenges difficulties with their mental health present.
Mental health difficulty makes you really, really poor
One of the things that people often forget about mental health difficulty is that, in common with other Disabilities, it tends to make you really, really poor. We talk about student debt as a problem of students futures, something that is parked as a problem for the time after leaving academia. But student debt is also a practical, day-to-day reality. When your wellbeing is suffering as a result of mental ill-health, things get very expensive very quickly. If you don’t pay for the things you need to feel safe, secure and on top of things with cash, you pay for them in the day to day quality of your life. Bad or inappropriate housing leave you with no home to feel comfortable in. Lack of money to pay for food and other essentials grinds you down. Travel and transport become a constant struggle.
Living with mental health difficulty is a series of acts of mitigation. Sometimes you have to buy your way around the things that are troubling you, if you can afford it. Being able to get a cab when getting the bus terrifies you might be the difference between getting to university or not. Without financial security, everything else walks a knife-edge between being bearable and being too much. Yes, people with enough money also have mental health difficulties, but we also know that the interaction between poverty and mental health is toxic.
In April 2018 the National Union of Students released the first report of their Poverty Commission. It found that Average student expenditure routinely exceeds the income available through student support. Leaving many students without the means to pay for food or heating. Student halls routinely exceed what is affordable given the maintenance loan available to students.
But, you say, students can work part time while they study. The NUS found that “Working-class students are most likely to be employed in a job that requires more than the recommended 15 hours per week while studying.” And that’s where mental health difficulties make things more complicated again. Mental health difficulties limit things that people can do. Things like studying all day then working all night. Or juggling finding time to study and time to earn money. If the basic level of student support available is inadequate, then your institution is assuming that money will be coming from somewhere.
As the NUS Poverty Commission notes: “access to discretionary or hardship funding from educational institutions is at best patchy. Central government funding for hardship support in HE in England ceased in 2014/15, and although some institutions have invested in hardship, in other areas it has been cut.”
A Department for Education report evaluating Disabled Students Allowances found that students with a mental health difficulty were more likely to feel uninformed about DSA than students with other types of disability. And Personal Independence Payment (The much maligned replacement for Disability Living Allowance) isn’t, should we say, the easiest of benefits to secure even if you are entitled to it.
Money worries and the practical challenges lack of money poses undermine life like a cavity undermines a tooth. This stuff matters. It can be tempting to see the majority of students as being like the unnamed subject of Pulp’s classic ‘Common People’ “laid in bed at night, Watching roaches climb the wall, If you called your Dad he could stop it all.” But they aren’t. If you care about the mental health of students, care about their financial security.
Implement real rights. Don’t rely on kindness
As institutions, universities must be fearless in working with other organisations to provide the care and support any member of the institutions for their mental health. If your university hasn’t already: begin to work with your local clinical commissioning group, GP practice group or mental health trust to explore in reach services. Mental health difficulties can’t always be resolved by a friendly chat or hep accessing money and support. Waiting lists for mainstream mental health services are such that by the time someone gets to the front of the queue, there’s a chance that either their degree will be over or their problems will have reached a point where reading lists and lab credits are the least of their worries. You know you will have students facing mental health difficulties. Don’t act surprised when they happen. Make firm relationships and even look to developing specific services. People can’t eat fine words. Make sure that there is another level of support with a clear offer if more traditional pastoral care and support isn’t enough to help someone.
Don’t rely on post graduate students to be your first line of mental health support. We’re not talking about homesickness or study tips here. I was talking to someone who spent a year as a halls tutor in a halls of residence and they told me that the difficulties they saw people having and the things they were witness to were far beyond their competence. They said this with anguish and frustration, not cynicism and resignation.
Peer support is amazing. Motivated, compassionate students can make a real difference for each other. People who have been there and done that supporting others who are currently going through the same can be a powerful way of passing on practical advice, emotional support and of making it so that no one feels like they’re the only one going through something but peer support has limits, especially in the context of a heavily transient population. Undergraduates are undergraduates for three or four years. Further up the academic tree it differs. Sometimes it’s not even clear who your peers might be, is it your supervisor? Others in your department? Your fellow students, if you ever actually see them? I recently wrote a piece about where people who experience mental health difficulties draw the line in supporting others where people shared their stories of times where they had to say ‘no more’, for their own mental health. The answer that people gave was that there were times when they had to ‘put their own oxygen mask on first’. Supporting people with mental health difficulties is a skill. Kindness is amazing, but not everything can be solved by other people having difficulties themselves. There has to be somewhere to go when that’s not enough.
Look to setting up specific services, perhaps in collaboration with your students union or with a local third sector provider. Having a place that people know they can go for mental health support and advice, including support in accessing funds and additional support can be invaluable. Don’t leave it to chance. The question must be: what can we offer our students and staff if all of the other stuff we offer doesn’t work or help?
Do not confuse raising awareness with providing support. Do not confuse wellbeing with mental ill-health. It is hugely important to make it clear to everyone involved with your institution that you have a clear, defined offer of support, adaptation and mitigation around mental ill-health, but that offer must have substance and must be accessible to everyone.
Treat mental health at university as a matter of life and death
In a 2017 blog post, Sara Ahmed wrote: “A complaint teaches about institutional direction because a complaint is often treated as misdirection by the institution. Another way of saying this: to locate a problem is to become the location of a problem.” There is an assumption that the institutions must be saved at all costs. Students with mental health difficulties don’t want to rock the boat. Students request adaptations and support or try to hide. They don’t complain. Institutional power means they accept that they are the problem, not the conditions which we saddle them with by not making universities ready for people with difficulties like theirs.
Make your offer explicit. Make your offers repeatedly. Make them until you’re bored, and everyone else is bored. What you offer your students to support their mental health should trip of everyone’s tongue as easily as a phone number or the name of your first pet. Put them in every email footer, in every official letter. Regularly poll students to see if they know who they should contact and where they should go if their mental health is troubling them. Regularly poll staff and faculty to check whether they know where to suggest students and staff should go for support, help and comradeship.
If you’re worried you’ll increase demand by publicising financial, practical and medical support or that you’ll run foul of the Daily Mail test and you’ll have a load of dude bros complaining about entitled ‘snowflakes’ and waving sardonic placards, then have a good look at yourself.
Information decays. A flyer on a noticeboard is soon covered with other flyers. A bit in the handbook or on the website is in a bottom drawer and never found when it’s needed. Do not wait for people to seek the information, as if it were a dirty secret hidden somewhere in a belfry. Make support and adaptation and security a right, not a gift. Keep saying ‘if you are feeling bad, or what’s happening in your life is scaring you or if you’re in trouble and can feel your academic dreams slipping from you here are the steps you can take.’ Stop your academic hand wringing and your pissing about and your-after-the-fact investigations when something makes headlines.
Don’t be so bloody academic about it. Get to work. People on your campus are suffering now. People are wondering if they’ll ever make it into the department again, wondering if they’ll be sacked, sent home, kicked out. People are feeling terrified and desperate in awful rooms and staring at books that they can’t concentrate on now. Treat it like it’s important. Treat it like it’s a matter of life and death. Make sure that things are in place for initiatives to continue. Fight for money. The real meat is what you embed in your institution so that becomes an integral part of how your institution functions. Mental health difficulty isn’t a novelty; it’s a painful part of everyday life which you can make less painful.
As I speak to you, people are asking ‘what do I do now?’ right now.
I’m not part of the academy. I’ve not got a degree. I care about knowledge and exploration and people getting where they want to be. We’re letting students down at a time when they feel they have least power. And it’s in recognition of all those students: alone, ashamed, scared, defeated and at their wits end that I bring this complaint.
Mental health at university needs to be more than just pastoral care.
@markoneinfour
